Self Harm (eBook)

1 What is self harm?

I wonder what has brought you to pick up this book today? Some of you will be reading it because you self harm. Some will be trying to find out more about what someone else is doing. Or perhaps you are just trying to find out more about a problem that used to be very unusual or even unheard of – and now affects so many people in the UK.

Self harm is something that most people find difficult to understand – a destructive impulse that doesn’t seem to make sense. Both sufferers and those who care for them sometimes find it hard not to feel critical towards those who self harm, and struggle with feelings of disgust about the wounds and the mess self harm creates. The reality, however, is that for millions of people in the UK right now self harm is something that they do regularly to help them cope with feelings that are out of control. In fact, self harm has increased dramatically in frequency in the UK over the last ten years. What used to be unusual and seen only in a small proportion of mental health patients now occurs in most schools, universities and clinics across the country. To understand why this is happening, we need to understand what self harm is, and how something that seems so destructive can become very addictive.

Let’s take the chance right now to explain clearly what we mean by the term ‘self harm’. Self harm is generally defined as acting to deliberately injure yourself physically. The exact form of harm varies, and ranges from minor, occasional acts to more serious and regular harm that can require hospital treatment. Some forms of self harm are invisible or do not leave a wound. These can include acts of hitting or punching or taking substances that cause pain or discomfort. Other forms create a visible wound, such as cutting or burning the skin. This kind of self harm is statistically the most common, with around two out of three sufferers saying that they use cutting as their main method. Meanwhile, some other sufferers may show more unusual kinds of self harm, such as deliberately breaking bones or pulling out hairs.1 Some people always harm in the same way; others use different methods according to what is available at the time. Some sufferers may harm specific parts of their body, whilst others may use anywhere that would be hidden by clothing.

One very important thing to be clear about when we use the term ‘self harm’ is the difference between self harm and acts that are part of an attempt to end life. Some research studies and medical papers use the term ‘deliberate self harm’ to include actions of attempted suicide, and it can be difficult to distinguish the two, particularly if very similar actions are involved – such as cutting wrists or taking overdoses. However, we do not include those things in our discussion because we – and the people we work with and support – find the distinction clear. The easiest way to understand the difference is to look at what that person intended to happen as a result of their actions. The self harm we are describing is not intended to end life. Instead it forms part of a coping strategy that the sufferer develops in order to help them to deal with emotions and feelings that are overwhelming. Self harm is an attempt to stop the barrage of emotion, depression and anxiety, to escape the accusatory thoughts that plague sufferers and to find a moment of peace and freedom.

Having said that, it is very important to be aware that self harm is often very closely linked to suicidal thoughts and attempts. Statistically those who self harm are many times more likely to attempt suicide than those who do not. Even those who are not suicidal may risk their life unintentionally if their harming becomes very serious. Most teenagers say they harm in an attempt to express distress and escape difficult situations. But every year some lose their lives, even though this was not their aim. It is important to be aware that the feelings that trigger self harm are very powerful. These are not people who are just feeling ‘a bit down’. Instead, powerful emotions – combined with repeated episodes of anxiety and depression – mean that many sufferers become increasingly desperate, and struggle to hold on to any hope of recovery or change. With that hopelessness can easily come thoughts of suicide. The dividing line between self harm and suicide can get increasingly thin, particularly for individuals who have suffered for a long time.

All this means that our definition of self harm needs to be expanded. In this book, therefore, when we use the term ‘self harm’ we mean acting to deliberately injure yourself physically in an attempt to cope with, express or reduce intense or overwhelming emotions. This is a slightly different definition from that used in, for example, the NICE (National Institute of Clinical Excellence) guidelines for self harm,2 and we hope that our reasons for making this distinction are clear. In common with NICE, however, we prefer the term ‘self harm’ to ‘deliberate self harm’. This is because, as we will discuss later in the book, some people harm when not fully in control of their actions, so we feel the word ‘deliberate’ is not always accurate. This book aims to discuss, explain and demystify self harm and to offer practical advice to help people cope with this issue as well as start to work towards recovery.

Now that we are clear what we mean by self harm, the next question usually asked is why people do it. This question, together with what makes self harm such an addictive behaviour, will be considered in more depth in Chapters 3 and 4, but in understanding what self harm is it’s important to be aware of the ways in which its exact nature can vary from sufferer to sufferer. Self harm is about doing something to yourself that has a negative physical outcome. It is a powerful communication of how intense emotional pain has become. Some people see self harm as a form of punishment, whilst for others there is something else in the act that helps them deal with how they are feeling – perhaps the visible wound, the releasing of blood or the experience of physical pain. For others self harm occurs impulsively and almost instinctively as a response to an emotion such as anger or frustration. This emotion is often directed inwardly, and sufferers become increasingly frustrated and angry with themselves, culminating in the harming. Sometimes self harm can become part of a deliberate and planned response to emotional pain. Sufferers report starting to feel overwhelmed by a desire to harm as their emotions build and become increasingly out of control. Self harm may then follow a strict routine.

So far we have talked about the kinds of self harm that are usually included in definitions and discussions on this topic. However, some people have argued that other behaviours which, although widely practised, also have possible or inevitable negative physical outcomes, should be included as types of self harm – such as alcohol abuse, smoking, unsafe sex and even eating disorders like anorexia and bulimia. Most people would not include these things when they talk about self harm, but it is certainly true that some people deliberately engage in such risky or unhealthy behaviours whilst in the negative emotional spirals that can be part of self harm. Therefore, sometimes it is appropriate to include such actions when considering the ways a person self harms. Eating disorders form a special case, with so many sufferers also self harming that the two are often very strongly linked. Some people with eating disorders specifically consider some of the things they do to be kinds of self harm. They might talk about purging to ‘punish’ themselves, or see pain experienced as something they ‘deserve’. So in this way behaviours that are part of another disorder can overlap with what we might consider to be self harm. Ultimately, almost any behaviour or addiction that has a negative physical outcome could potentially be part of a wider continuum of self harm.

Another hotly debated area of ‘self harm’ is the question of body piercing and tattooing. Most professionals agree that such things, done apparently as an expression of style and as a statement of some kind, can in fact sometimes be a form of self harm. However, many people who have numerous body piercings or tattoos...